| NPI | 1336776269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 76024) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101026998) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2024-03-05 |